COPD is the acronym for Chronic Obstructive Pulmonary Disease, a disease of the lungs that is progressive in nature, and can greatly limit an individual's quality of life. The hallmark of COPD is the breathlessness and cough it causes with the people that are suffering with the disease. COPD is actually two chronic diseases of the lungs. With COPD, these two diseases occur simultaneously, which dramatically obstructs the airflow and interferes with the gas exchange whereby oxygen is delivered to the lungs and carbon dioxide is exhaled. These two diseases are chronic bronchitis and emphysema, two names many people are very familiar with.
One of the most important aspects of understanding any condition and how it may affect you, family member or friend is to better understand fact from fiction. Let's start off with some actual facts about COPD. COPD is the 4th leading cause of death in the United States and there are an estimated 12 million Americans diagnosed with the disease currently and another 12-14 million who have the disease but are undiagnosed. The 2010 calendar year was the seventh consecutive year women have exceeded the number of deaths of men attributable to COPD. Smoking is the primary risk factor for the development of COPD. With 85-90% of deaths from COPD directly linked to smoking, it has become a primary target for prevention. In 2010, the cost to the nation for COPD was projected to be approximately $49.9 billion, including $29.5 billion in direct health care expenditures, $8.0 billion in indirect morbidity costs and $12.4 billion in indirect mortality costs.
To best understand COPD you really need to understand the anatomy of the lungs.The airways are shaped like an upside-down tree with many branches. At the end of the branches are tiny air sacs with very thin walls called alveoli (al-VEE-uhl-eye).Small blood vessels called capillaries run through these thin walls of the air sacs. When air reaches the air sacs, the oxygen in the air passes through the air sac walls into the blood in the capillaries. At the same time, carbon dioxide (a waste gas) moves from the capillaries into the air sacs. This process is called gas exchange. When you breathe in, the air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out of the lungs.
In COPD, less air flows in and out of the airways and air sacs because of one or more of the following:
- The airways and air sacs lose their elastic quality (not as stretchy).
- The walls between the air sacs are destroyed.
- The walls of the airways thicken due to swelling and inflammation.
- The airways make more mucus than usual, which tends to clog them.
The primary cause of COPD is cigarette smoking, but we should discuss briefly the other causes of this condition. Any type of chronic exposure to lung irritants such as chemicals, dust or fumes, second hand smoke all are causes of COPD in the adult. Although it is rare, there is a genetic condition called Alpha-1 Antitrypsin Disease (AAT) which can cause COPD. This form of COPD or lung disease usually goes undiagnosed until people reach the age of 40-50 and become symptomatic with shortness of breath. We will not go into discussion for this article on AAT but understand it does exist and is just as severe as the environmental type COPD.
Since airflow obstruction is a key part of COPD, doctors will measure airflow to diagnose and gauge the severity of COPD. The most common airflow test is a type of breathing test called spirometry. Spirometry is a non-invasive and cost effective test that measures the airflow in your lungs. The test needs to be performed by a trained healthcare professional, usually in a doctor's office or a hospital setting. In the test, you place a small mouthpiece in your mouth and take a few deep breaths in and out in a forceful manner to allow for the airflow to be measured. The testing may take between 20-60 minutes. This test allows for the doctor to not only diagnose you but, more importantly, determine what stage of COPD you are in. The severity of your COPD is measured by staging &ndash a higher stage means more severe disease &ndash and knowing this helps your doctor determine a course of treatment.
You should be asking yourself, if this diagnosis is so easy to find and cost effective why there are an estimated 12 million Americans undiagnosed each year. The reality is in many cases your doctor may not ask about your shortness of breath at all and if he/she does they usually do not associate it with COPD until many years later. The other important aspect of an early diagnosis is for you to talk to your doctor. Don't be afraid to tell your physician about how you feel and why you think things are different. An example of this may be, "I used to climb the stairs with a laundry basket all the way to the top. Now I need to stop and rest 2 times to catch my breath."
The treatment for COPD really revolves around managing the symptoms you have that are reducing your quality of life. You see, the lung damage caused by COPD cannot be reversed, but you can preserve the lung tissue you have left.
First, if you're still smoking, quit. If you have environmental exposures, remove yourself from them. There are inhaled medications such as bronchodilators, which relax the airways when tight, and anticholinergics, which help reduce the mucus production in the airways. In the early stages of disease your doctor may prescribe medications that are short acting and move to longer acting medicines later. Steroids may be prescribed to decrease airway inflammation, too. There is oxygen therapy, if needed, to help with the low oxygen problem we discussed before as part of the disease. A yearly flu vaccine is imperative to get, since anyone with a lung disease such as COPD will have their symptoms worsen if they contract influenza. The pneumococcal vaccine is also recommended.
Pulmonary Rehabilitation is a supervised exercise program that should be used to improve your cardiovascular conditioning, muscle strength, education and understanding about your disease and finally has been shown to improve the quality of life significantly for people with COPD.
The final two treatment options for COPD are surgical. Lung transplantation may be an option in some cases but has a high risk of complications. The lung transplant would be considered in cases where medications are not working. The final surgical option is the lung volume reduction surgery (LVRS). This is done for patients where the lung damage is located in particular locations in the lungs such as the upper lobes. Removal of the damaged tissue allows for the undamaged air sacs to be recruited and start working again.
There are many challenges for people with COPD, and there is currently no cure. The best choices are to not be in the situation and work toward prevention. Quit smoking if you have started and if you have not started don't start. If you are exposed to lung irritants and you feel yourself becoming more short of breath or have a chronic cough, tell your doctor. You need to remove yourself from the environment or face chronic changes to the lungs that cannot be reversed. There is an emotional toll that is paid by yourself and family members, so it is important to network with others. I have listed a few networking websites for your reference below that would be worth your time.
NHLBI.NIH.GOV
LUNGUSA.ORG
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